Alerts

New Coverage for Novavax COVID-19 Vaccine (for Non-Pharmacy Providers)

10/16/2023

PDF Version:


TO: Hospital Providers, Physicians, Nurse Practitioners, Physician Assistants, County Health Departments, Federally Qualified Health Centers, and Rural Health Clinics

 

RE: New Coverage for Novavax COVID-19 Vaccine (for Non-Pharmacy Providers)

 

Information in this Provider ALERT is in coordination with the ALERTs published January 11, 2021, March 24, 2021, January 13, 2022, July 26, 2022, August 15, 2022, October 4, 2022, October 5, 2022, November 10, 2022, November 22, 2022, February 8, 2023, April 20, 2023, June 26, 2023, and October 4, 2023.

 

Effective for dates of service on or after October 3, 2023, Medicaid covers the following new procedure code for COVID-19 vaccines.


Procedure Code

Procedure Code Short Descriptor

Age Restriction

Medicaid Rate

91304

SARSCOV2 VAC 5MCG/0.5ML IM

12y - older

$148.20


Medicaid enrolled providers should not bill for the vaccine if using federally-allocated vaccines.

 

To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll.

 

Providers must follow state and federal laws and regulations regarding administration of the vaccine, as well as state and federal standing order guidelines for products granted Emergency Use Authorization (EUA).

 

Providers with billing questions should contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989.


     The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American Medical Association
     and © 20
23 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.